Cancer is no laughing matter — or is it?

Tig Notaro, subject of a new documentary, famously shared her breast cancer diagnosis with her comedy club audience at Largo in Los Angeles just hours after she heard the news. "It's weird because with humor the equation is tragedy plus time equals comedy," she said. "I am just at tragedy right now."

One of my mom’s best friends was in a horrible car accident when she was in her 60s.

“I’m sorry to tell you this,” the doctor gravely informed Thelma after they stabilized her in the ER, “but you may never walk again.”

Without skipping a beat, the lifelong practical joker quipped, “Can I dance?”

That’s sort of how things went after I was diagnosed with breast cancer. I didn’t have Thelma’s quicksilver recovery time. Like a lot of people who’ve just heard those three little words, “You have cancer,” I was a confused, angry, sobbing mess. But then my favorite coping mechanism kicked in and I started cracking wise at cancer’s expense.

The radiologist who told me the bad news became Dr. Debbie Downer. When people asked what stage I was, I’d tell them “Exit Stage Right.” Before my first CT scan, I asked the lab techs if they would serve me the contrast drink in a martini glass and, at chemo, suggested the nurses post signs reading “Free Brazilian with every infusion!”

I was terrified, of course, just as I’m sure Thelma was there in the ER, but the jokes helped me process the horrible thing that was happening to me. Humor helped me diminish it, take away some of its terrible power. It was a way to keep my fear, and that of my friends and family, in check – for a moment, at least.

Four years out from diagnosis and treatment, I’m still cracking jokes and taking potshots at this crappy disease. And I’ve found many a kindred spirit.

Comedian Tig Notaro, the subject of a new documentary, has famously milked her breast cancer for material, claiming she badmouthed her small boobs so much they finally got sick of it and decided to kill her. Others, like cancer besties Kristen Howard and New York Times columnist Suleika Jaouad have produced darkly funny parody videos, like Real Housewives of Chemotherapy, as a way to cope.

But cancer humor is complicated – not everybody finds it funny, or useful. And there are times when it can backfire. So is tumor humor truly healthy? Is confronting cancer – and even death – with bad jokes and black comedy good for us, as patients?

“It just makes things less awful,” the mother of two added. “As someone who will live with disease for the rest of my life, to never laugh again would be horrific. The jokes make me feel better. To some extent, I get to decide how I’m going to cope and I tell jokes.”

Not everyone uses humor to cope, said Dr. Bonnie McGregor, a psychologist and public health researcher at Fred Hutchinson Cancer Research Center who works with cancer patients.

“Not everybody finds it helpful," she said. "It can be hurtful if the timing isn’t right or the situation isn’t right. So you have to be careful with it.”

Too true. A year out from my diagnosis, it was still hard to hear others make jokes about my bald head or "killer boobs," even if I had made similar cracks myself. Tragedy plus time equals comedy, the old saying goes. The farther you get away, the easier it is to laugh. And there are some things that are never funny.

Overall, though, laughter is very good medicine, said McGregor. And studies back that up.

Laughter is fast-acting, too. A randomized controlled trial of a “therapeutic laughter program” found that breast cancer patients’ anxiety, depression and stress were reduced after just one session of laughing in various ways including “laughing together with dance routines.”

Oh, science. You never disappoint.

Not-so-funny business

Caldwell said when she once joked to her oncologist that she was going to start a life of crime because “by the time they catch me, I’ll be dead,” he got very upset. People will react as if you’ve “stabbed them in the gut,” she said. “They’re horrified that this is happening and you’re laughing about it.”

Others respond to jokes about cancer and death with stony silence or the occasional stink eye.

Rita Stein, who died of lung cancer in 2013, leaned heavily on black humor to leaven her last days, said daughter Deana Hendrickson, who acted as her mom’s caregiver. Hendrickson once pretended to smother her mother with a pillow in her hospital bed while a conspiratorial nurse snapped a photo because her mom found it so hilarious.

Deana Hendrickson (inset top) and her late mother Rita Stein (inset bottom) used gallows humor like this staged "mercy killing" as a way to deal with Rita's stage 4 lung cancer diagnosis. "It lightened her last days," Hendrickson said.

Photos courtesy of Deana Hendrickson

The pair also got in trouble for cracking up in the waiting room before her mom’s first radiation treatment.

“She turned to me and said, ‘What’s the worst that can happen? I’ll get cancer?’ and we couldn’t stop laughing,” said Hendrickson, who now advocates for lung cancer patients. “People were shooting daggers at us but one woman came up and said, ‘Don’t pay any attention. You just made my year.’”

Cancer, Hendrickson said, somehow “freed” her mom.

“There were plenty of times when she was really sick and wasn’t in any shape to be funny, but if she was feeling just a little bit better, she would absolutely joke around,” she said. “My mom had a terrible childhood and I think she just learned to look at the world that way. She was always a character and became more of a character after her diagnosis.”

I suppose the same could be said for many of us.

Cancer is the gift that keeps on giving whether you’re talking physical or emotional pain, debilitating side effects, abject grief – or, great new material to entertain your family and friends. And as we all know, there’s much to mock, from those brutal, open-backed patient gowns to the tragically flawed health care system to cancer drugs that all sound like characters out of Game of Thrones (“One day, Taxotere, you will be king!”).

But yucking it up can also go too far. I’ve come home from get-togethers with non-cancer friends drained from trying to make everybody comfortable by turning my cancer into a stand-up comedy routine.

Apparently, I’m not the only one who falls into this trap.

“I think humor is a great coping mechanism, but it can also be a way to push away the serious,” said Leslie Heron, a nurse practitioner with the Fred Hutch Survivorship Program at Seattle Cancer Care Alliance. “Some people are so jovial that others don’t know they need support. I don’t have any problem with people using humor as long as they’re able to accept help or support as they need it.”

Using humor to heal

Wisecracking through cancer is loaded territory, to be sure. But for me, it helps. It helps to see Facebook posts of women going off to chemo wearing Viking outfits. It helps to watch parody videos like #BaldSoHard and see a grown man in a pink tutu dancing across the U.S. and the Internet on behalf of women and men with breast cancer. For me, it’s healthy – it’s healing – to be irreverent and snotty and silly and, at times, joyfully absurd.

Because I know one day I may be in Thelma’s shoes and find myself lying on a hospital bed with a doctor in a white coat hovering over me, solemnly delivering some very big, bad news.

Cancer’s funny that way.

So like my mom’s friend, I’m going to continue to crack wise. And take potshots. And dream of dancing even when I can’t walk. I’m going to keep asking cancer, in the immortal words of Thelma, to kindly pull my finger.

Do you use humor as a way to cope with cancer? Tell us about it on Facebook.

Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she also writes the breast cancer blog doublewhammied.com. Reach her at dmapes@fredhutch.org.

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